Surgical hip dislocation with relative femoral neck lengthening and retinacular soft-tissue flap for sequela of Legg-Calve-Perthes disease.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: C.S. Leibold, N. Vuillemin, L. Büchler, K.A. Siebenrock and S.D. Steppacher declare that they have no competing interests. 20. J Pediatr Orthop. 2024 Jan 1;44(1):e57-e60. doi: 10.1097/BPO.0000000000002554. Epub 2023 Oct 23. Ipsilateral Healthy-segment Response to Leg Length Discrepancy. Birch JG(1), Makarov MR, Jo CH. Author information: (1)Texas Scottish Rite Hospital for Children, Dallas, TX. BACKGROUND: Few studies address frequency or magnitude of healthy lower-extremity segment response to ipsilateral companion segment shortening. We sought to document and quantify this occurrence in a variety of pediatric etiologies. METHODS: We reviewed the medical record and radiographs of patients undergoing epiphysiodesis to manage leg length discrepancy. Inclusion criteria for this study were leg length discrepancy of a single lower-extremity segment by identifiable cause and adequate scanograms to allow accurate measurement of all 4 lower-extremity segments before any surgical treatment for the discrepancy. We recorded the etiology of shortening, age of onset of disorder, the length of the lower-extremity segments on scanograms, and age at the time of radiographs. We considered ipsilateral healthy-segment difference from the contralateral ≥ 0.5 cm. as clinically significant. RESULTS: Two hundred nine patients met inclusion criteria (126 boys, 83 girls). The average age was 12.5 years. 16/60 patients with avascular necrosis of the hip demonstrated ipsilateral tibial shortening averaging 1.2 cm whereas 6/60 demonstrated ipsilateral tibial overgrowth averaging 0.6 cm. 11/30 Legg-Perthés patients demonstrated ipsilateral tibial shortening averaging 0.7 cm; none had ipsilateral tibial overgrowth. 10/42 posteromedial bow patients had ipsilateral femoral shortening averaging 0.8 cm, whereas 6/42 had ipsilateral overgrowth averaging 0.8 cm. 13/48 with distal femoral physeal injury demonstrated ipsilateral tibial shortening averaging 1.2 cm, whereas 6/48 demonstrated ipsilateral tibial overgrowth averaging 0.8 cm. 8/29 tibial physeal injuries (proximal or distal) demonstrated ipsilateral femoral shortening averaging 1.1 cm. whereas 7/29 demonstrated ipsilateral femoral overgrowth averaging 0.7 cm. CONCLUSIONS: Although there are individual exceptions, the ipsilateral healthy segment does not grow appreciably more than the contralateral in patients with avascular necrosis of the hip, Legg-Perthés disease, or physeal trauma. The femur is not a significant component of shortening in patients with posteromedial bow. LEVEL OF EVIDENCE: Level III, retrospective review. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/BPO.0000000000002554